Strengthening global health security through health early warning systems: A literature review and case study.

Disease transmission is dependent on a variety of factors, including the characteristics of an event, such as crowding and shared accommodations, the potential of participants having prolonged exposure and close contact with infectious individuals, the type of activities, and the characteristics of the participants, such as their age and immunity to infectious agents [1-3]. Effective control of outbreaks of infectious diseases requires rapid diagnosis and intervention in high-risk settings. As a result, syndromic and event-based surveillance may be used to enhance the responsiveness of the surveillance system [1]. In public health, surveillance is collecting, analyzing, and interpreting data across time to inform decision-making and aid policy implementation [1]. In this review article we aimed to provide an overview of the principles, types, uses, advantages, and limitations of surveillance systems and to highlight the importance of early warning systems in response to the information received by disease surveillance. The study conducted a comprehensive literature search using several databases, selecting, and reviewing 78 articles that covered different types of surveillance systems, their applications, and their impact on controlling infectious diseases. The article also presents a case study from the Hajj gathering, which highlighted the development, evaluation, and impact of early warning systems on response to the information received by disease surveillance. The study concludes that ongoing disease surveillance should be accompanied by well-designed early warning and response systems, and continuous efforts should be invested in evaluating and validating these systems to minimize the risk of reporting delays and reducing the risk of outbreaks.

Healthcare policies, precautionary measures and outcomes of mass gathering events in the era of COVID-19 pandemic: Expedited review.

With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.

Prognostic factors and treatment outcomes in pediatric autoimmune encephalitis: a multicenter study.

Introduction: The last few decades have increased our understanding of autoimmune encephalitis (AE). In both the pediatric and adult populations, it proves to be a disease of dramatic acute onset of heterogeneous clinical manifestations, notably encephalopathy with neuropsychiatric symptoms, seizures, and extrapyramidal symptoms. More often, it is triggered by a viral infection in the pediatric age groups, as suggested by the preceding febrile symptoms in over half of cases, and more ostensibly, NMDAR encephalitis post herpes encephalitis. An underlying neoplasm may be present in certain types (i.e., NMDAR encephalitis). The rising rate of antibody detection and subsequent confirmation has been boosted by improved live cellular assay detection methods. The corresponding clinical phenotypes, common underlying malignancies, and histopathological findings have helped improve our management regarding intervention and choice of immunotherapy. New assessment tools such as the Clinical Assessment Scale in Autoimmune Encephalitis (CASE score) have helped improve the objective assessment of impact on cognitive functions (1). Early intervention with immunotherapy (and tumor removal in proven underlying neoplasms) has improved overall outcomes in most presenting patients. But nearly 40% of cases fail to respond to the first tier of treatment (2). The complex interplay between pathogenic autoantibodies, T-cells, B-cells, and cytokines has led to the emergence of additional immunotherapy agents (i.e., tocilizumab and bortezomib). Methods: In this retrospective observational study of pediatric AE conducted at two tertiary care centers, we observed the clinical characteristics, autoantibody yield, treatment modalities used, and disability scores during presentation and follow-up. Our secondary aim was to delineate prognostic factors for poor outcomes. Results: Neuropsychiatric symptoms, encephalopathy, and seizures were the predominant manifestations in most of our patients. Younger age groups, refractory seizures, profound encephalopathy, and refractory disease harbored higher disability scores. The group that received combined immunotherapy has shown mitigation of disability score from severe to mild during long-term follow-up, signifying the role of multifaceted immunotherapy in pediatric refractory AE. Conclusion: Early implementation of combined immunotherapy in refractory cases significantly improved longterm disability scores, in spite of lingering residual effects on neurologic functions, notably cognition, behavior, and speech.

Healthcare Providers' Experience with Saudi Arabia's 937 Virtual Medical Call Centers and Telehealth.

Introduction: This cross-sectional descriptive study evaluates the experiences and perceptions of healthcare providers (HCPs) regarding the 937 medical call center in Saudi Arabia, a key telemedicine initiative. Aim:  To assess HCP satisfaction, identify challenges, and provide recommendations for improvement. Methods: Conducted from November 20th to December 15th, 2022, the study surveyed 454 HCPs, achieving a 90.5% response rate. Results: A majority (86.8%) of respondents were satisfied with the call center, valuing its ease of use and effectiveness in healthcare delivery. However, challenges such as the accuracy of remote medical assessments, the need for clearer telehealth regulations, and concerns over management support and consultation overlaps were identified. The study also highlights the importance of ongoing support and updates, comprehensive telehealth regulations, integration of more medical specialties, and improvements in system integration and data confidentiality. Conclusion: The study underscores the need for strategic enhancements to the 937 call center to further improve healthcare accessibility and efficiency in Saudi Arabia. These enhancements are vital for aligning telehealth services with Saudi Arabia's healthcare objectives under Saudi Vision 2030.

Osteoporosis: a study of knowledge, attitude and practice among adults in Riyadh, Saudi Arabia.

Osteoporosis is a growing chronic health problem that could result in mortalities and poor living quality. This study aimed at assessing the awareness of adults in Riyadh about this disease and its associated factors as well as compare KAP levels of men and women. A cross sectional study including 505 participants was conducted in several malls of Riyadh city during March 2012, selected by stratified random sampling technique. Self-administered questionnaire was used for data collection. 86% of the participants had heard of osteoporosis. Media was the main source for Participants' knowledge; the mean knowledge score was 56.6% of the maximum achievable score. There was significant differences in knowledge scores by educational level, employment, income and residence (P = 0.005), (P = 0.008) (P = 0.0122) and (P = 0.009), respectively. Participants had low frequencies of preventive practices, especially females who had a mean total score equivalent to 48.8% of the maximum score, while males' mean score was 54.7% (P = 0.000). Perceived susceptibility was higher among females (83 vs. 74%, P = 0.000), and thus had less perception of the barriers to preventive actions, than men (49.6 vs. 55.5%, P = 0.000). Self-efficacy and perceived benefits had the highest scores (95% of the maximum achievable scores). Considerable number of adult males and females are unaware about osteoporosis. Since there is deficiency in the knowledge, and poor application of the preventive actions. Therefore, Education programs are needed to improve awareness and motivating healthy behaviours.

Assessment of Parental Knowledge, Awareness, and Perception About Autism Spectrum Disorders in Aseer Region, Southwestern Saudi Arabia.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects young children in social relatedness and communication besides other characteristics. A community's awareness and early intervention services in diagnosing and treating autistic children are essential for preventing the expected complications, eg language delay, social interaction, and intellectual ability. Aim: To assess the parent's knowledge and perceptions regarding autism and its associated clinical features and effects. Methodology: A cross-sectional study was conducted targeting all available parents aged 18 years or more living in Aseer region. Data were collected using a self-reported questionnaire from randomly selected parents who attended outpatient clinics at Abha Maternity and Children Hospital and Aseer Central Hospital. Parents' knowledge regarding autism was assessed covering general knowledge, clinical features, social effects, consequences, and curability. Results: A total of 477 parents participated. Parents' ages ranged from 18 to 85 years. 261 (54.7%) parents were male and 216 (45.3%) were females. Nearly 65.6% of parents were university graduates and 28.3% had a secondary level of education. About 50.9% of the parents know that genetics play a major role in causing autism, 69.6% think that most children with autism have special talents or abilities, 64.2% know that delayed language development is one of the main symptoms of autism, 61.2% also know that repetitive movements of the hands and head are a common symptom of autism. About 36.9% of parents think that diagnosing a child with autism will lead to discrimination against the child, 33.3% of parents think that autism is a rare condition in this country compared to the West. Conclusion: The study showed that parents had poor knowledge levels regarding autism and its related clinical features, especially male parents with low levels of education. On the other hand, their perception of the disease and its frequency in the study area was satisfactory.

Application of Automated External Defibrillators Among the Public: A Cross-Sectional Study of Knowledge, Attitude, Practice, and Barriers of Use in Saudi Arabia.

Background: The likelihood of survival of an out-of-hospital cardiac arrest quadruples with the rapid application of basic life support (BLS). The public's ability to perform cardiopulmonary resuscitation (CPR) and use automated external defibrillators (AEDs) is extremely important. This study aimed to assess the public knowledge, attitudes, and practices (KAP) of utilizing AEDs and to understand barriers to AED application. Methods: We conducted a cross-sectional study from March 1-30, 2022. An electronic questionnaire was constructed and validated to measure the KAP for public AED utilization and its barriers. Results: Of the 406 participants, 244 (60.10%) were males. Male respondents had 17% less knowledge and poorer attitude towards using an AED as compared to female respondents. Knowledge and attitudes on using AEDs were low (70.7%) among Saudi nationals compared to those of foreign nationals. Those who were BLS/CPR trained had a 2.5 times greater understanding and willingness to use AEDs in public than those who were not. Barriers to AEDs in CPR/BLS-trained participants were: (1) accidentally hurting the victim (14.3%), (2) duty as a bystander to just call the ambulance and wait for help (12.1%), (3) never taught what to do (n = 41, 18.4%), (4) did not want to be scolded if performed wrong (3.1%), and (5) never witnessed such a situation (51.6%). Conclusion: There is a strong association between knowledge of and willingness to use AEDs in emergency situations among the public. Misconceptions about AEDs hinder their use. This calls for urgent training programs through accessible technology to reach the public.

Mitigation strategies for heat-related illness during mass gatherings: Hajj experience.

Introduction: To mitigate morbidity, mortality, and impacts of heat-related illnesses (HRIs) on health, it was vital to implement a comprehensive framework for HRI prevention and control. A recognized tool from the field of trauma prevention known as the Haddon matrix was applied. The matrix states that any event is affected by three factors: host, agent, and environment. In addition, another recognized tool known as the combined model was used in this study. The combined model is a three-dimensional model that includes the idea for the three axes of Haddon's matrix with the methodology of the community risk reduction (CRR) model. Aim of the study: To identify the environmental and individual risk factors of HRIs based on the Haddon matrix and the recommended prevention strategies by the CRR tool by using the combined model. Methodology: An extensive literature review was conducted to assess all the risk factors associated with HRI, as well as preventive measures. Then the Haddon matrix was used to structure, separating human factors from technical and environmental details and timing. After that, the combined model was used to set all responses and mitigation measures for each element obtained from the Haddon matrix tool. Conclusion: Projected increases in heat stress over the globe require the formulation and implementation of evidence-based HRI mitigation and preventive measures. In this study, we implemented the combined model that was utilized as a systematic strategy for the more theoretical framework of Haddon's matrix. Using the Haddon matrix to determine the HRI risk factors and the combined model to mitigate its impact was practical and helpful in planning, preparedness, and mitigating the HRIs during Hajj, provided a broad approach equivalent to the Swiss cheese model, and would facilitate an informed decision.

Post-acute COVID-19 condition in Saudi Arabia: A national representative study.

BACKGROUND: Many survivors of COVID-19 have developed symptoms and diseases similar to those observed after severe acute respiratory syndrome (SARS). Therefore, this study aimed to characterize the symptoms that appear after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been eradicated and to determine their relationship with COVID-19 severity. METHODS: This multicenter, retrospective cross-sectional study was conducted in all eligible confirmed cases of SARS-CoV-2 infection from Saudi Arabia. Study participants were randomly selected using computerized random sampling from a population of 314,821 patients. Descriptive statistics were used to describe baseline demographic data and clinical characteristics. Categorical variables were presented as counts and percentages, while continuous variables were presented as means and standard deviations. RESULTS: Approximately 70% of patients were found to have five or fewer symptoms simultaneously. Late symptoms (in the ongoing symptomatic COVID-19) occurred in 225 (22·5%) patients with the most common late symptoms being loss of smell, loss of taste, fatigue, shortness of breath, and cough (52·4%, 31·1%, 11·5%, 10·2%, and 8·9% of patients with late symptoms, respectively). We also found that the presence of acute symptoms of COVID-19 and admission to the hospital were significant independent predictors of the post-COVID-19 condition. CONCLUSION: Saudi patients with COVID-19 develop a wide range of symptoms, similar to those observed and reported in other countries. The loss of smell, the loss of taste, shortness of breath, and fatigue were the main persistent symptoms. Regular follow-up of COVID-19 survivors is highly recommended to minimize the burden of the post-acute COVID-19 condition and improve the quality of life of patients.

Hospital Visitors' Awareness and Adaptation of Preventive Measures for Middle East Respiratory Syndrome Coronavirus.

OBJECTIVE: This study aims to assess the knowledge and awareness, and to identify the practice reflection of knowledge concerning Middle East Respiratory Syndrome (MERS) on hospital visitor's daily life. METHODS: A cross-sectional study, conducted in 2 tertiary referral hospitals in Riyadh Saudi Arabia, from February 2015 to February 2016. A total random sample of 305 hospital visitors consented to participate. Data were collected through a self-administered questionnaire consisting of questions regarding awareness and practice of measures to prevent the spread of infection. RESULTS: Study showed that participants have a fair knowledge regarding the cause of MERS (N = 228; 74.8%). Nearly half of them (47%) stated that camels are the source of the spread of MERS. Approximately 70% of the participants preferred both sanitization and wearing facemasks as preventive measures for MERS. However, only 3.95% practiced not eating camel products, such as milk and meat. CONCLUSIONS: Although hospital visitors showed some knowledge and positive awareness in several aspects of MERS awareness, there are weak areas where knowledge and awareness were not up to recommended guidelines. Continued educational programs are needed to improve awareness and knowledge of all the public toward MERS-coronavirus infection. This study may assist in the development of future strategies on preventive measures of the disease.

A combined model for COVID-19 pandemic control: The application of Haddon's matrix and community risk reduction tools combined.

INTRODUCTION: To mitigate morbidity, mortality, and impacts of COVID-19 on health, it was essential to implement a comprehensive framework for COVID-19 control and prevention. A well-recognized tool from the field of injury prevention known as the Haddon matrix was utilized. The matrix states that any accident is affected by the host, agent, and environment. Another well-recognized tool used by the national fire protection association known as the Community risk reduction tool (CRR). The (CRR) tool utilizes the Five E's of Community Risk Reduction. AIM OF THE STUDY: To describe the risk factors that increase the susceptibility and the severity of COVID-19 infection based on the Haddon matrix and the proposed prevention strategies by the CRR tool by using the combined model. METHODOLOGY: We reviewed the literature to assess known factors contributing to COVID-19 susceptibility, infection, and severity of infection. We then used the Haddon matrix to structure, separating human factors from technical and environmental details and timing. We then used the community risk reduction (CRR) model to set all responses and control measures for each element obtained from the Haddon matrix tool. Subsequently, we incorporated both tools to develop the combined model. CONCLUSION: we proposed and implemented a combined model that utilizes the CRR model as the systematic strategy for the more theoretical framework of Haddon's matrix. Combining both models was practical and helpful in planning the preparedness and control of the COVID-19 pandemic in Saudi Arabia that can be generalized to national and international levels.

Hajj 2021: Role of mitigation measures for health security.

PURPOSE: After the impressive results of the 2020 Hajj management, Saudi authorities decided to expand the quota to 60,000 pilgrims in 2021, which resulted in a convenient and successful experience. PATIENTS AND METHODS: This was a retrospective pre and post-study study conducted on all pilgrims attending the 2021 Hajj using the polymerase chain reaction (PCR) test surveillance with paired-swab samples (pre-Hajj and post-Hajj) to evaluate the risk potential of COVID-19 among Hajj pilgrims, the effectiveness of preventive measures and the potential effect of the Hajj ritual as a huge mass gathering on the epidemiological situation of the Saudi Arabian population. RESULT: Forty-one cases had positive COVID-19 infections out of a total of 58,428 pilgrims who attended the 2021 Hajj season, as detected by nonmandatory pre- and post-Hajj PCR. Notably, the 2021 Hajj season achieved a decreasing leg of the COVID-19 pandemic curve. The adjusted incidence rate in KSA from July 11th to August 7th ranged from 19 to 24 cases per 100,000 population. In contrast, the incidence rate for the same duration in Hajj ranged from 3 to 7 cases per 100,000 pilgrims. CONCLUSION: The Saudi mitigation plan ensured the safety of pilgrims and healthcare workers for Hajj, successfully limited the risk of COVID-19 transmission inside and contributed to global health security. The success story of Hajj in 2020 and 2021 during the pandemic represents a successful model for planning, achieving and managing future mass gatherings by integrating technology with global and national health policies and public health measures.

Perceptions of Parents towards COVID-19 Vaccination in Children, Aseer Region, Southwestern Saudi Arabia.

Vaccines are an important part of the COVID-19 pandemic response plan. This cross-sectional study aims to assess the attitude and perception levels of parents toward COVID-19 vaccines for children aged 0-18 years in the Aseer region of Saudi Arabia. Data were analyzed using SPSS version 16.0. Out of a total of 1463 parents, 30.6% assumed that COVID-19 vaccination may be more dangerous for children than adults. Nearly 36.5% parents don't have any concern about children's vaccination. About 12.8% of children have not received the vaccination, 55% of parents have some sort of hesitation and 32.2% of parents did not hesitate before vaccinating their children against COVID-19. Only 15.4% of parents expect that the COVID-19 vaccine affects their child's genes. About 23.4% parents strongly agreed and 35.1% agreed about the importance of getting their children vaccinated. About 22.1% of parents strongly agreed and 33.3% agreed regarding their willingness to get their children vaccinated to prevent Coronavirus disease. More than 80% of parents recommended rushing to receive the COVID-19 vaccine. Health professionals and policymakers should implement and support strategies to ensure children are vaccinated for COVID-19. They also need to educate parents and families regarding childhood vaccination.

Independent Association of 25[OH]D Level on Reduced Glutathione and TNF-α in Patients with Diabetes and/or Hypertension.

Purpose: Oxidative and inflammatory pathways play a significant role in the pathophysiology of a wide variety of non-communicable diseases such as type 2 diabetes mellitus (T2DM) and hypertension. However, the effect of serum 25-hydroxyvitamin D (25[OH]D) on these pathways is still controversial. To evaluate the association of 25[OH]D on antioxidant and pro-inflammatory biomarkers, reduced glutathione (GSH) and tumor necrosis factor (TNF)-α, in T2DM and hypertensive patients. Patients and Methods: This is a cross-sectional study of a consecutive sample of patients attending the the Family Medicine clinic at King Abdullah bin Abdulaziz University Hospital (KAAUH). Participants were screened for eligibility according to the following criteria: aged above 18 years and diagnosed with T2DM and/or hypertension for at least one year. Patients receiving any kind of vitamin D or calcium supplements within the last three months were excluded, as were those with a history of renal failure, cancer, liver, thyroid, or any other chronic inflammatory diseases. Results: In total 424 T2DM and/or hypertensive patients (mean age 55±12 years) were recruited. In addition to routine physical and laboratory examinations, levels of serum 25[OH]D, GSH and TNF-α were measured. The prevalence of 25[OH]D deficiency (<50 nmol/L) was 35.1%, which was independent from GSH and TNF-α levels. In T2DM, hypertensive and patients having both diseases, GSH levels were 349.3±19, 355.4±19 and 428.8±20 µmol/L, respectively. Uncontrolled T2DM and hypertension patients showed significantly higher GSH compared with the controlled group. Males showed slightly higher level of TNF-α compared with females and uncontrolled hypertensive patients had relatively higher TNF-α level when evaluated against controlled hypertensive patients. . Conclusion: 25[OH]D level is independent of oxidative stress and inflammation, assessed by levels of GSH and TNF-α, respectively, in T2DM and hypertensive Saudi patients. .

SARS-CoV-2 Positivity in Early Infancy: A National Cohort From Saudi Arabia.

Background: Data on SARS-CoV-2 in infants ≤ 90 days are limited with conflicting reports regarding its presentation and outcomes. Methods: We conducted an ambispective cohort study using prospectively collected Health Electronic Surveillance Network Database by the Ministry of Health, Saudi Arabia. Infants of ≤ 90 days of age who had a positive RT-PCR test for SARS-CoV-2 virus were included. Patients were divided in Early neonatal (0-6 days), late neonatal (7-27 days), and post- neonatal (28-90 days) groups and were compared for clinical characteristics and outcomes by contacting parents and collecting information retrospectively. Results: Of 1,793 infants, 898 infants were included for analysis. Most infants in the early neonatal group had no features of infection (tested based on maternal positivity), whereas most infants in the late and post- neonatal groups were tested because of clinical features of infection. Fever and respiratory signs were the most common presenting feature in the late and post-neonatal groups. Hospitalization was higher in the early neonatal group (80%), compared to the two other groups. The overall mortality in the cohort was 1.6%. Conclusion: SARS-CoV-2 infection in infants ≤ 90 days might not be as rare as previously reported. The clinical presentation varies based on age at positive RT-PCR result.

Primary health care reform in Saudi Arabia: progress, challenges and prospects.

BACKGROUND: Saudi Arabia embarked on transforming its primary health care system in 2016 to meet international standards, gain the people's trust and respond to the growing burden of noncommunicable diseases, as proposed in the Saudi Vision 2030. AIMS: This review aims to highlight the progress, identify challenges and prospects for Saudi Arabia's PHC reform process in order to make recommendations to facilitate strengthening of the PHC system. METHODS: A review of previous studies and governmental reports was undertaken to extract, analyse, synthesize and report the findings. RESULTS: The review has indicated that by mid-2019, the reform has contributed to an increase of 37.5% in the rate of PHC visits and 4.7% increase in patient satisfaction, enhanced coverage of rural communities (from 78% to 83%), and contributed to increasing the screening rate for prevalent chronic diseases. However, the country still faces gaps and challenges pertaining to human resources issues, cultural and lifestyle behaviour, geography, intersectoral collaboration and PHC infrastructure. CONCLUSION: PHC reform process in Saudi Arabia has demonstrated that positive change is achievable. This has been aided by building on previous accomplishments and the wealth of experience gained throughout the PHC journey in Saudi Arabia. However, despite improvement in the quality of services, continuous improvement is required to meet the rising expectations of the population.

Risk Communication Effectiveness During COVID-19 Pandemic Among General Population in Saudi Arabia.

PURPOSE: The novel coronavirus (COVID-19), declared a pandemic by WHO in March 2020, is an unprecedented occurrence in our recent history. Effective risk communication by health authorities, through relaying reliable and authoritative information, is imperative in combating the spread of the outbreak. We aimed to measure the effectiveness of risk communication campaign and overall awareness during COVID-19 pandemic among the general population in Saudi Arabia. PATIENTS AND METHODS: A cross-sectional survey of 5472 individuals in Saudi Arabia was conducted to assess several factors regarding the risk communication messages during the COVID-19 pandemic, including the knowledge and response of the general population toward COVID-19 and MoH efforts. The questionnaire was divided into five main sections: general knowledge of COVID-19, channels and social media platforms used perceived risk and stress or panic toward COVID-19, satisfaction and community perception, most trusted source of information, and type of information received. RESULTS: A total of 5472 individuals participated in the study residing in Saudi Arabia. Overall knowledge of COVID-19 was determined to be above average (0.58 + 0.159). Of the general population, 57.1% perceived that the risk of getting sick with COVID-19 is low, while nearly half of the respondents (45.7%) have a high level of stress and panic toward COVID-19. The majority of responders to the questionnaire reinforced that MoH was their most trusted source of information for the COVID-19 pandemic (91.7%). CONCLUSION: This study showed that the risk communication campaign by healthcare authorities during the COVID-19 pandemic has improved the awareness among the general population in Saudi Arabia, where the overwhelming majority placed high trust in the MoH as its main reference for COVID-19 information.

Predictors of Hospitalization Among Older Adults with COVID-19 in Saudi Arabia: A Cross-Sectional Study of a Nationally Representative Sample.

BACKGROUND: The aim of this study was to identify the predictors of hospitalization in older (≥60 years) patients with coronavirus disease-19 (COVID-19) in Saudi Arabia. METHODS: Patients were randomly selected from a COVID-19 database maintained by the Ministry of Health, Saudi Arabia. All patients were aged ≥60 years, had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19, and were registered in the database during March 2020 to July 2020. Medical and sociodemographic characteristics were retrieved from the database. Additional data were collected by telephone interviews conducted by trained health professionals. Descriptive statistics and multiple logistic regression analyses were used to analyze the relationship between patient characteristics and the risk of hospitalization. RESULTS: Of the 613 included patients (51.1% females), more than half (57.3%) were between 60 to 69 years of age, and 53% (324/613) had been hospitalized. The independent predictors of hospitalization included age ≥65 years (OR = 2.35, 95% CI: 1.66-3.33, P < 0.001), having more than one comorbidity (OR = 1.55, 95% CI: 1.09-2.20, P = 0.01), diabetes mellitus (OR = 1.52, 95% CI: 1.09-2.11, P = 0.01), hypertension (OR = 1.40, 95% CI: 1.007-1.97, P = 0.04), chronic kidney disease (OR = 3.87, 95% CI: 1.41-10.58, P = 0.008), and history of hospital admission within the preceding year (OR = 1.69, 95% CI: 1.11-2.55, P = 0.013). Risk of hospitalization was lower in males (OR = 0.65, 95% CI: 0.43-0.90, P = 0.01) and in patients co-living with health care workers (OR = 0.64, 95% CI: 0.43-0.96, P = 0.03). CONCLUSION: Factors associated with higher risk of COVID-19-associated hospitalization should be used in prioritizing older adults' admission. Future studies with more robust designs should be conducted to examine the risk of COVID-19-associated illness severity and mortality.

The Role of Digital Technology in Responding to COVID-19 Pandemic: Saudi Arabia's Experience.

INTRODUCTION: The novel coronavirus (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-chain ribonucleic acid (RNA) virus. As of March 25, 2021, the total number of positive cases and fatalities in the Kingdom of Saudi Arabia (KSA) had reached 386,300 and 6624, respectively, with a case fatality rate of 1.71%. The KSA was among the leading nations to heed the advice of WHO officials and put strict precautionary and preventive measures in place to curb the early spread of COVID-19 before it was declared a global pandemic. METHODOLOGY: This was an uncontrolled before-after study following a mixed-method approach for data collection. National and regional data were extracted from the Health Electronic Surveillance Network (HESN), a centralized public health collection system for quantitative and statistical data. Quantitative and qualitative methods have been utilized in studying data derived from tech media. RESULTS: The Saudi authorities utilized different technological tools to aid in managing and combating the COVID-19 pandemic. In the case of Al Madinah Al Mounawarah, after the implementation of several technologies, the most important being Tawakkalna, the number of active daily cases decreased by 61%. CONCLUSION: The use of the Tawakkalna application was proven to be a successful method in fighting the COVID-19 pandemic in the KSA. This vital and essential experience warrants the use of different digital technology that offers a personalized profile displaying the person's status (affected, vaccinated, or no history of infection). This application played and will continue to play a crucial and effective role in pandemic containment in Saudi Arabia.

Clinical profiles associated with SARS-CoV-2 infection and complications from coronavirus disease-2019 in children from a national registry in Saudi Arabia.

CONTEXT: Exploring clinical characteristics of coronavirus disease-19 (COVID-19) in children may help in prevention and treatment guidelines. AIMS: The aim of the to describe the spectrum of pediatric COVID-19 in Saudi Arabia. SETTINGS AND DESIGN: A multicenter, retrospective, cross-sectional study involving pediatric COVID-19 patients across all Saudi regions. METHODS: All patients aged between 2 months and 18 years with a confirmed diagnosis of COVID-19 were included. The primary end point was the hospitalization. STATISTICAL ANALYSIS USED: Descriptive statistics were used to describe the baseline demographic data and clinical characteristics. Numerical data were explored using Kolmogorov-Smirnov test and Shapiro-Wilk test, while Chi-square or Fisher's exact test were used for categorical data. RESULTS: Among the 654 pediatric COVID-19 patients, 4.7% (n = 31) were hospitalized, with one patient only needing pediatric intensive care admission. Sex, breastfeeding, birth status, and the patients' living environment showed no significant association with hospitalization. Most children (80.3%, n = 525) were symptomatic, with two symptoms that were significantly associated with admission, namely, vomiting (P = 0.007) and nausea (P = 0.026). History of admission within the last year was identified in 10.4% (n = 68) children but had no association with worse outcome. The median duration of hospitalization for the entire group was 5.5 days, with longest hospital stay for age group 7-12 years (median 6 days). CONCLUSIONS: COVID-19 is usually a milder disease in children. Although having preexisting medical conditions was linked to a longer hospitalization, it was not associated with worse outcome. Continuous surveillance will allow additional characterization of the burden and outcomes of pediatric COVID-19-associated hospitalizations.